Laboratory
Laboratory Billing Processes and Services
Laboratory testing spending has a steady increase over the years. Medicare spending has increased from USD 7.1 billion in 2017 to USD 9.3 Billion in 2021. But it dropped to USD 8.4 billion in 2022 and this overall 10% drop compared to previous year 2021 was majorly caused by less Covid 19 test (14%), genetic testing (26%) and the lowest decline in number (3.6%) for general chemistry and other test. MTServices, with it's experience of laboratory billing, provides a comprehensive laboratory billing and coding services. With Efficient RCM, knowledge, use of external tools, and keeping updated with guidelines, we have effectively reduced accounts receivable (AR) aging for clinical billing. We have expertise dealing in DNA billing, toxicology billing, and pathology billing services, with ability minimising backdated issues.
Our experienced and skilled billing team can handle various laboratory sections, including clinical, toxicology, molecular, and pathology. Consider MTServices as your one-stop-shop for not only laboratory billing solutions but also overall medical billing and coding solution provider for individuals, groups, independent or hospitals labs pathology groups etc.
POTENTIAL REIMBURSEMENTS FOR LABORATORY SERVICES
The 2014, Protecting Access to Medicare Act (PAMA) required CMS - Center for Medicare and Medicaid to align the medicare laboratory test payment rate with private payers which resulted in estimated savings of USD 670 million. Without insurance, top 10 most popular lab tests (CBC, CMP, TSH, Lipid panel etc) can cost roughly from USD 45 to USD 1039 and some can go into multiple thousands. Lab testing is generally covered by private insurances as well as Medicare. The price for each test by private insurance depends on your Co pays and deductibles and their coverage, whereas Medicare reimbursement goes by Clinical laboratory fee schedule (CLFS) - THE CLFS is set of payment rates established under the new payment system by CMS regulated by PAMA.
The CLFS defines the maximum amount that Medicare is allowed to pay for each lab test and the rate is baed on private payment reported one year prior to 3 year defined period. For example, rates for period 2021 to 2023 were based on 2019 private payments with maximum allowable fall in rate to be 15% decrease/year. Beginning 2024 there is no limit on maximum rate fall according to PAMA.
MTServices has achieved exceptional outcomes in Laboratory billing. We attribute our success to keeping up to date with guidelines, regulations, Rules changes on federal or state level. We are aware that genetic test number decreased from 1.9 Billion in 2021 to 1.4 billion in 2022 and one of the reason was potential fraudulent billing practices by providers.
Laboratory Billing Solutions
MTServices, with certified staff possesses knowledge, experience, skills to handle laboratory billing process. Starting from patient registration and check with insurance for lab and services test cover, use of correct CPTs, ICDs, and Modifiers for labs. Our strength lies in remaining constantly updated, continuous education, regular training and ever present Audits.
We make RCM more efficient by using Automated eligibility tools With real-time eligibility checks, Laboratory Information System (LIS), Clean Claim Submission and timely filling of claims with precision, and a intelligent follow-up system, MTServices ensures that claims are processed and paid accurately and promptly.
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